“Education is the most powerful weapon which you can use to change the world.” -Nelson Mandela
Learning the art, science and craft of medicine is both a lifelong pursuit and potentially one of life’s great adventures. The culture and impact of health care is tied to the experience, cost and outcomes of medical school. Medical education has slowly evolved over the last century, standing on the shoulder’s of giants such as Osler, Cushing, the Mayo brothers and Flexner. Their vision, shared by the AAMC, ACGME, AMA and The Joint Commission, that learning is best done by doing, that clinical practice is scientific method ethically and empathically applied, that medicine and medical education are a public service and a calling, and that clinical practice requires both science and humanism, is still relevant today.
Yet there are clearly competing interests to this vision. The exponential growth of medical knowledge, the rising costs and pressures of modern health care and an educational finance system that devalues education and clinician educators can crowd out such aspirations. Meanwhile, the breadth of knowledge and skill required of the future doctors will only increase, requiring expertise in systems management, bioinformatics, and quality improvement. In addition, the rise of digital participatory culture and instant information access challenge many of the traditional approaches to medical education. But with these challenges come enormous opportunity.
The opportunity is for an education that is efficient as it is effective, that is motivating and inspirational, that is individualized yet reliable, that is inclusive and inexpensive. In the debate over how to improve education simple concepts are often left out: that education itself should be efficient, inspirational and low cost and that it should improve continuously and quantifiably. While there is research on expert reasoning in a clinical setting and suggestions as to how teachers can coach novice clinical reasoners, we have little data on how students learn from day to day. Current classrooms, courses, and didactic methods give us little information. Medical education is ripe for reform.
The following articles make the argument for why, what the principles are that should inform education reform and the education that would result. The Carnegie Foundation sponsored a new “Flexner Report” in 2010, which touched on many of issues in medical education today. The following Vision for a New Education was inspired by both the 1910 and the 2010 reports and like them is a call to action. I hope the ideas will be of use and welcome comment, discussion and critique.
This design emerged from a thorough examination of individual reflections by students, residents and physicians, the study of learning science, the investigation of the medical education market and a comparative analysis of training in other fields. Though I believe the principles and resulting design that follow are well founded both practically and theoretically, the importance I place on practice and the learning environment can also be traced to my life as an artist. My background as musician, director, producer and composer lent a particular perspective to my years in medical school. I hope this perspective offers some value to future students and their patients.
This work is indebted to numerous thinkers that have labored over the past century to improve how we think about the learning mind and to the educators, doctors and researchers who are pushing the envelope of the current education.
About the author:
Ben is a MacArthur award winning designer, health professional and musician. Prior to medical school, he directed the multimedia-music ensemble Ardesco and was the co-founder of the Musicians’ Alliance for Peace, a global organization that produced hundreds of concerts on all 7 continents. He holds a doctorate of musical arts and has taught violin, music theory, physics, climbing and the practice of medicine. He earned his MD from Stanford University School of Medicine. He is fascinated by education across disciplines and is inspired by the human mind’s capacity to learn, the great adventure learning can be and the joy that learning can bring.